When a drug company develops a new drug, they’re the only ones allowed to make it and sell it for a while under their “brand name.” At some point, other companies are allowed to start making “generic” versions of it. These versions have the same active ingredients and quality standards, but cost less.

Some plans require you to use a generic version when there is one, or you may need to pay a higher copay or your percentage of the costs (known as coinsurance) for the brand version (if there is a generic available). Check your plan details to see how your plan works.

Yes. The Food and Drug Administration (FDA) will not approve a generic drug unless it’s A-rated ("therapeutically equivalent"). It must be identical to the brand-name version — same active ingredients, dosage and strength and medical effect.

Your physician and pharmacist are the best sources of information about generic medications. Simply ask one of them if your prescription can be substituted with an equivalent generic medication.

If your current prescription medication is not a generic, call your doctor and ask if it's appropriate for you to switch to a lower cost generic drug. The decision is up to you and your doctor.

You can also select the “Save on My Prescriptions” link on the pharmacy section of the website where you can view savings opportunities. You’ll get information to discuss with your doctor and the tools to get started.

You may request that your doctor prescribe the brand-name drug even when a generic version is available. However, you may have to pay the difference in cost between the generic and brand-name drug, plus the co-payment.

When your doctor gives you a prescription for a drug, take it to a pharmacy in your network. Show your member ID card so the pharmacist can access your benefits. If you have ongoing medicines you take, you may be able to get them sent right to your door.

You can log in and use our Find a Doctor tool to help you find a pharmacy. You can also see and manage your prescription benefits or start home delivery.

A medication list (sometimes called a formulary) is a list of prescription medications approved by the U.S. Food and Drug Administration (FDA). Our drug lists are made up of brand name and generic drugs that have been reviewed through our Pharmacy and Therapeutics (P&T) process. This group meets regularly to review new and existing drugs and choose medications based on safety, effectiveness and value.

Our drug lists have different tiers or levels. Medications in Tier 1 have the lowest member cost share, while members pay more for drugs in higher tiers.

Your coverage has limitations and exclusions. It’s best to refer to your Certificate/Evidence of Coverage or Summary Plan Description (SPD) for details about what’s covered and what’s not.

Most of the time, you can take your prescription to the pharmacy and get it filled. But some drugs have special requirements that need to be met before your prescription is covered. We want to ensure members receive appropriate medication amounts and are using proven, cost effective drug therapies. Our clinical programs/edits help us monitor drug list compliance, clinical appropriateness, medication safety, refill frequency, dispensing limitations, and overall cost and quality consistency:

Prior Authorization: Prescriptions for certain drugs may require “prior authorization” from a health benefits plan before they can be filled. Some drugs require prior authorization because they may not be appropriate for every member or may cause side effects. Prior authorization helps promote appropriate utilization and enforcement guidelines of prescription drugs. Your doctor will request a prior authorization on your behalf.

Step Therapy: Step therapy involves requiring the usage of a drug, drug regimen, or treatment prior to the usage of another drug, drug regimen, or treatment. In instances in which a drug, drug regimen, or treatment is not effective and/or appropriate for a particular member, the step therapy requirements allow the doctor to then prescribe a different drug, drug regimen, or treatment.

Quantity Limits: Overuse of drugs can be unsafe for members. With quantity limits, members receive the drug amount that is approved for benefit coverage for a certain length of time, and coverage of a prescription is rejected if the amount prescribed exceeds recommended prescribing guidelines.

Our medication list (sometimes called a formulary) allows you and your doctor to choose from a wide variety of prescription drugs. Please talk with your doctor about prescribing a drug that is on the medication list. If a drug is selected that is not on the medication list, you will be responsible for the full cost of the drug. You can also talk to your doctor about making a request to Express Scripts for an exception review of a drug not on the medication list.